Nurse-led spine clinic yields high patient satisfaction
The majority of patients would prefer to see specially trained nurse practitioners for back pain than wait to see a surgeon, findings from a Canadian study suggest.
The successful pilot study, led by Angelo Sarro, MN, RN, CNN, demonstrated that referring patients with certain spinal conditions to NPs significantly sped up the diagnosis and management of their condition without sacrificing satisfaction.
In the United States, 60% of patients wait longer than four weeks to see a specialist compared to 57% in Canada, 46% in Australia and 40% in the United Kingdom, according to the Canadian College of Family Physicians.
“Waiting times for specialty consultations in public health care systems worldwide are lengthy and impose undue stress on patients waiting for further information and management of their condition,” Sarro said in a press release. "Back pain can be very unpleasant and debilitating and 85% of us will experience it at some point in our lives."
She assessed a total of 177 pre-selected patients with disc-herniation, spinal stenosis and degenerative disease at a Toronto Western Hospital clinic in Ontario, Canada, from January to December 2008.
Sarro's clinical diagnoses matched those of two reviewing orthopedic spine surgeons from the hospital, Yoga Raja Rampersaud, MD, and Stephen Lewis, MD, 100% of the time for all 177 patients, and she suggested the same management plan as the two surgeons in 95% of cases. Fewer than 10% of patients (n=18) were identified as surgical candidates.
Overall patient satisfaction, as measured by patient questionnaires, was high at 96%. In regard to specific components of care, 97% of patients reported that they happy with the NP consultation, 94% expressed satisfaction with the thoroughness of the examination, and 91% said that they understood their condition better following the exam.
Furthermore, data indicated that overall wait times for all patients were reduced to just 12 weeks, compared with average wait times of three-to-four months to see a surgeon for disc herniations, and eight-to-twelve months to see a surgeon for spinal stenosis.
When patients were asked if they would have preferred to see a surgeon in a conventional clinic, 26% said yes, but 77% of these patients said they would be unwilling to wait an extra three-to-four months for care.
“We believe that our study demonstrates that nurse practitioners can play an effective and efficient role in delivering timely health care to patients requiring specific disease management in a specialty setting,” Rampersaud said in a statement.
“Although skill levels will vary from one [NP] to another, physicians can work with them to help them to develop expertise in their specialty area,” he added.
The full study, along with a consultation satisfaction questionnaire, is available in the December 2010 issue of the Journal of Advanced Nursing.